Provider Demographics
NPI:1467416404
Name:DHAVALE, ANANT K (MD)
Entity Type:Individual
Prefix:
First Name:ANANT
Middle Name:K
Last Name:DHAVALE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2403 N LAURENT ST
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-4119
Mailing Address - Country:US
Mailing Address - Phone:361-579-0315
Mailing Address - Fax:361-579-0325
Practice Address - Street 1:1501 BURNET RD
Practice Address - Street 2:
Practice Address - City:BROWNWOOD
Practice Address - State:TX
Practice Address - Zip Code:76801-8520
Practice Address - Country:US
Practice Address - Phone:325-649-3307
Practice Address - Fax:325-645-5459
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM6105207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8V9071OtherBLUE CROSS
F56561Medicare UPIN
TX8J6307Medicare PIN
TXP00448353Medicare PIN